A federal program that aimed to improve kids’ access to healthy food significantly reduced obesity rates in children from low-income families, according to a new study.
The 2010 passage of the Healthy, Hunger-Free Kids Act was associated with a 47% reduction in obesity prevalence in low-income kids, Harvard researchers found in a study published in Health Affairs that analyzed more than 173,000 students. That translated to 500,000 fewer cases of obesity among low-income kids, the health policy experts estimated, advocating for expanding access to the program as well as maintaining the act’s original standards.
Nearly 6 million 10 to-17-year-olds lived in poverty in 2018, according to the study.
“When healthier eating habits like eating more fruits and vegetables, more whole grains than refined grains, and consuming less protein and less sugary drinks are established at a young age, those track into adulthood well,” said Erica Kenney, assistant professor of public health nutrition at the Harvard T.H. Chan School of Public Health and lead author of the study. “Regardless of weight status, those habits are important for all of us in reducing the risk of chronic disease.”
The Healthy, Hunger-Free Kids Act changed the meal patterns for breakfast and lunch served at schools to increase the amount of fruit and vegetables served and limit starchy vegetables; customize serving sizes based on age; serve only low-fat or fat-free milk; and serve more whole grains versus refined grains. For the first time, it established standards for food and beverage sold outside of the school programs, offering healthier options from vending machines and school stores.
The act aligned the National School Lunch Program and School Breakfast Program—which had not been updated in more than 15 years—with science-based recommendations from the National Academy of Medicine. These programs are particularly essential for lower-income children, who tend to use them more than other kids and can qualify for free or reduced-price meals, researchers said. The share of students who identified as living in poverty increased from 14.8% in 2003 to 16.9% in 2018, they found.
More families will fall into poverty this year as the country endures COVID-19, which highlights the importance of these types of programs, Kenney said. The results suggest that since the beneficial change to obesity risk did not extend to children in poverty, policymakers could try to increase participation among students who are not currently eligible for free and reduced-price lunch, researchers said.
“The access issue in terms of the higher prices of healthier foods is a really big policy issue that I am not sure how to solve. But this is something that until we do solve it, makes healthy meals available to kids in a really simple way,” Kenney said. “It doesn’t put the burden on the working poor to navigate the system that is not set up to have healthy eating habits.”
Obesity, which burdens 18.5% of 2- to-19-year-olds in the U.S., increases the risk for a host of chronic diseases like cancer, type 2 diabetes and cardiovascular issues, Kenney said. Increased investment in this program to broaden its reach would likely more than offset higher healthcare expenses for sicker individuals down the road, she said.
There is also emerging evidence that shows that a healthy diet helps protect against respiratory diseases like COVID-19, Kenney added.
“Being able to prevent these earlier is really huge,” she said. “Losing weight as an adult or at any time of life is really difficult—anything we can do so people don’t have to do it in the first place is good public health policy.”
Even though schools’ adherence to the new meal and snack standards has been high (80+%) and students consume more fruit, vegetables and whole grains, there has been substantial industry and political pushback to the school nutrition legislation. Critics contend that standards must be relaxed to reduce food waste—a trend that researchers said has not materialized—and limit compliance burdens.
The Trump administration rolled back the nutrition standards for sodium and whole grains in 2018, but a Maryland federal judge recently vacated the rule. The administration proposed another rule earlier this year that would allow schools to serve fewer non-starchy fruits and vegetables, researchers noted.
“The big thing that we can do is stop trying to rollback the original standards,” Kenney said. “There should be a larger, coordinated conversation about policies we can set that establish what kind of foods are available for people.”